The U.S. response to a spreading Ebola outbreak in Congo is struggling with a self-inflicted wound: the decimation of USAID, the federal agency that for decades anchored America's disease-detection network overseas. Former government officials say the absence is costing lives and speed at the worst possible moment.
Last year, the Trump administration gutted USAID, canceling most of its programs and laying off the majority of its workforce. About 1,000 remaining programs shifted to the State Department. The result, according to a dozen former federal employees interviewed by NBC News, is a fragmented U.S. response to an outbreak that was likely spreading undetected for weeks before it was identified last week in the Democratic Republic of Congo.
As of Wednesday, the WHO counted 600 suspected cases and 139 suspected deaths, though actual numbers are believed to be far higher.
"What we've lost is speed, which is the most important thing in an outbreak like this," said Nicholas Enrich, former acting assistant administrator for global health at USAID. Enrich and others argue that USAID's field presence and deep relationships in affected regions could have compressed response time. The agency's programs historically helped labs detect viruses faster, rushed protective equipment to hospitals, and deployed local health workers to screen for symptoms and trace contacts.
That infrastructure evaporated. Dr. Daniel Bausch, a former CDC medical officer now at the Geneva Graduate Institute, described skilled community health workers who had responded to past outbreaks suddenly unemployed. "Now they're driving a taxi in Kinshasa or selling fruit somewhere," he said. "So this cadre of reasonably trained people that you can employ just isn't around."
The International Rescue Committee, a major USAID contractor, was forced to downsize operations in Ituri, the outbreak's epicenter, cutting back surveillance and sanitation work. Heather Reoch Kerr, IRC's country director for Congo, said reduced funding has crippled the group's ability to distribute protective equipment. "Today many facilities in affected areas are operating without basic protective supplies," she stated.
The detection delay itself illustrates the problem. A health worker reported Ebola-like symptoms on April 24, but local officials didn't identify the virus strain until three weeks later. Lab technicians in Ituri lacked proper equipment to test for Bundibugyo, a rare Ebola variant with no approved vaccine. They set samples aside instead of shipping them immediately. When samples eventually reached Kinshasa, they traveled at the wrong temperature in wrong quantities, complicating analysis.
Enrich said USAID would likely have caught such gaps and intervened directly. "The fact that this has been circulating for this long indicates that the system has degraded," said a former USAID official who requested anonymity to protect professional relationships. "Under USAID, the U.S. had people directly involved in the emergency operations center in DRC who would be aware of laboratory capacity and when things weren't running well."
The State Department flatly denies the reorganization hampered Ebola response. "It is false to claim that the USAID reform has negatively impacted our ability to respond to Ebola," spokesman Tommy Pigott said. The department mobilized $23 million in foreign assistance and announced funding for up to 50 emergency clinics. State officials argue that USAID partners still operate on the ground and that no specific person or program from USAID would have detected this particular outbreak anyway.
The CDC has expanded its role in the outbreak, with offices in Congo and Uganda handling surveillance, diagnostics, contact tracing and PPE distribution. Dr. Satish Pillai, the agency's incident manager for Ebola response, said the CDC has roughly 30 staff in Congo and nearly 100 in Uganda, with plans to deploy more. But critics say the CDC, while technically expert on Ebola, lacks the regional infrastructure USAID provided. The agency's epidemiologists can validate lab work and advise on protocols. They cannot easily substitute for the boots-on-the-ground coordination network USAID maintained.
"They're not equipped or prepared or organized to coordinate a broad response," Enrich said of the CDC's expanded mandate. "Their job is more making sure that the tests that are coming in are handled properly and the results are distributed effectively."
Bausch echoed the concern. CDC staff lack language skills, local knowledge, cultural familiarity, and security expertise in the region. The outbreak zone lies in territory recently contested between the Congolese government and the M23 rebel group. "Working with USAID in east Congo is the only way to control Ebola," said a CDC official with direct knowledge of past outbreaks who requested anonymity because they lack authorization to speak publicly.
The WHO's role adds another complication. The U.S. withdrew from the organization last year after Trump accused it of botching the Covid pandemic response. The WHO coordinates internationally, provides technical expertise, and arranges medical supply delivery during outbreaks. That partnership gap could matter as the crisis spreads.
In hospitals on the outbreak's front lines, the shortage is tangible. Dr. Herbert Luswata, a physician at Bwera Hospital in Kasese, Uganda near the Congo border, reported severe shortages of N95 masks, disposable aprons and gloves. "We are really very scared," he said. "We are not safe at all." Luswata noted that some former USAID contractors are volunteering but face uncertainty about payment. The CDC, he said, has not yet visited the facility despite moving quickly in past outbreaks.
"The response is too slow and inadequate, not anywhere close to the standards that are required in a response for an epidemic like Ebola, which we know has a very high fatality rate," Luswata said.
Author Sarah Mitchell: "Firing the infrastructure before the fire starts is a strategy that tends to backfire spectacularly when disease shows up at the door."
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